Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services-A Retrospective, Comparative Study.

In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions. OBJECTIVE: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers. METHODS: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Demographic data and clinical information were collected. The analysis of data was performed using descriptive analysis and frequency statistical tests. RESULTS: out of 100 participants, 63% of the PSN who received care in the private sector and the remaining 37% of PSN registered with public-funded care providers, aged 6 to 80 years old, were treated under GA. Autistic spectrum disorder was the most common medical diagnosis recorded (33%). More than half (52%) of the PSN treated by private care providers sought specialist care in an outpatient setting prior to GA vs. 5% of the PSN treated by public-funded providers. The utilization of sedation prior to GA was more common in the private sector. A vast majority (86%) of all subjects underwent multiple dental extractions (86%) and restorations (62%). CONCLUSIONS: comprehensive dental care under GA, which composes an integral part of special care dentistry, can be safely provided in a hospital setting, in both private and public sectors. While early intervention using sedation and behavioral management partially mitigates the need for dental care under GA, the vast majority of PSN may require dental treatment under GA in future to facilitate complex dental care.

Atypical oral candidiasis in a psoriatic patient during targeted immunotherapy with an interleukin 17 inhibitor (secukinumab).

BACKGROUND: Secukinumab is a human monoclonal antibody immunoglobulin that neutralises interleukin (IL)-17A, and as such, is effective in the treatment of psoriasis. However, as IL-17A is essential in protection against fungal infections, patients treated with this drug may develop candidiasis. This report presents a case of atypical oral candidiasis occurring during targeted drug immunotherapy with an interleukin 17 (IL-17) inhibitor (secukinumab), with the aim of emphasisinge the necessity of periodical oral health assessment and monitoring. It provides a rational clinical approach to therapeutic protocol in the treatment of side effects associated with novel medications for autoimmune diseases. CASE PRESENTATION: Symptomatic tongue lesions were observed in a 50-year-old female patient on a monthly systemic treatment of 300 mg of secukinumab, which appeared after 60 days of using the medication. Two inconclusive biopsies and an unsuccessful application of oral corticosteroids made the diagnostic process challenging. Papillae on the back of the tongue were atrophied, forming a well-defined erythema and white non-detachable plaques on the lateral border of the tongue. Cytopathological and histopathological exam results were compatible with a diagnosis of oral candidiasis. Topical antifungal medication led to subsequent regression of the tongue lesions. During asymptomatic period and follow up for 7 months, a reduced monthly dose 150 mg of secukinumab was administered. CONCLUSIONS: Patients undergoing treatment with IL-17 blockers, such as secukinumab, should be carefully monitored in order to avoid oral side effects resulting from the use of this medication.

Contribution of benzodiazepines in dental care of patients with special needs.

BACKGROUND: Conscious sedation in dental treatment of patients with special needs (PNEs) has the purpose of controlling events such as anxiety and fear, as well as promoting muscle relaxation and mastery of uncoordinated movements. Benzodiazepines (BZDs) are among the most used drugs due to their anxiolytic, hypnotic and sedative properties. The objective of this investigation is to demonstrate a study on the contribution of conscious sedation with BZD in PNEs. MATERIAL AND METHODS: The study included 40 PNEs, non-collaborators, submitted to conscious oral sedation with Midazolam (0.5 mg/kg) for dental treatment, receiving vital signs monitoring in the pre, trans and postoperative periods. RESULTS: Male patients were more frequent with 70% of the cases, with a mean age of 18 years. As for medical diagnosis, autism and mental deficiency were the most prevalent. The most performed procedures were restoration (32%) and exodontia (30%). There was a statistically significant reduction in systolic and diastolic blood pressure parameters (p<0.05) in the transoperative and postoperative periods when compared to the preoperative period. Conscious sedation with BZDs resulted in 83% positive responses. CONCLUSIONS: The results demonstrate that this technique is safe and effective, and can be used in outpatient care for PNEs. However, the risk/benefit ratio should be correctly evaluated. Key words:Special patients, oral sedation, benzodiazepines, midazolam, dental care.